Current outcome of heart transplantation: a 10-year single centre perspective and review

the gold standard therapy for advanced heart failure, is lim-ited by donor availability; alternative therapies are now becoming available. Aim: We examined the outcome of HTx with cur-rent immunosuppressive and adjunctive therapy. Design and methods: We analysed the outcome of 399 consecutive patients who underwent transplant-ation at our centre (1995–2007). Prior to HTx 23 % (98) required inotropic support, 8.5 % (34) an intra-aortic balloon pump and 11 % (43) a ventricu-lar assist device. Results: Actuarial patient survival was 86 % at 30 days, 79 % at 1 year and 62 % at 10 years. Survival was similar regardless of the heart failure severity, P=0.22. The cumulative incidence of allo-graft vasculopathy, Costanzo grade 2, was 7 % at 5 years and 23 % by 10 years with an 11 % cumu-lative probability of requiring a percutaneous coronary intervention by 10 years. Allograft function was preserved with a mean SD left ventricular ejection fraction of 73 7 % at 1 year and 74 8% at 10 years. The cumulative incidence of malignancy by 10 years was 27 % (skin malignancy 13 % and post transplant lymphoproliferative diseases 10%). The cumulative incidence of developing chronic kidney disease (CKD) with an estimated glomerular filtration rate 45ml/min/1.73m2 was 42 % at 1 year, 62 % at 5 years and 72 % at 10 years and of requiring long-term renal replacement therapy was 10.6 % at 10 years. Conclusion: HTx provided good medium-term survival for patients with advanced heart failure, independent of its severity. The incidence of allograft vasculopathy was lower than reported pre-viously but malignancy and CKD remain cause for concern